MEDICARE: LYNDA A BORSDORF CNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	209007741	IL

General Provider Information

NPI Number	:	1952534380
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LYNDA A BORSDORF CNP

Provider Business Mailing Address
First Line	:	421 W STEPHENSON ST
Second Line	:	PO BOX 268
City	:	FREEPORT
State	:	IL
Zip	:	61032
Country	:	US
Telephone Number	:	815-599-7958
Fax Number	:

Provider Business Practice Location Address
First Line	:	160 W MAIN ST
Second Line	:
City	:	LENA
State	:	IL
Zip	:	61048-9247
Country	:	US
Telephone Number	:	815-369-3300
Fax Number	:	815-369-4262

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/02/2009
Last Update Date	:	10/18/2017

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